(Cth) Dedicate MBS Items for Gender-Affirming Surgeries

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Author:  Jessica Luu & Emmaby Barton Grace | Publish date: 23/1/2026

TW: Gender dysphoria, anti-trans discrimination in healthcare settings, suicide

• P: There are currently no dedicated Medicare Benefits Schedule (MBS) items for gender-affirming surgeries for adults experiencing gender incongruence.

• S: The Minister for Health should leverage Section 3C of the Health Insurance Act 1973 (Cth) to introduce dedicated MBS items for 30 gender-affirming chest, genital, face, and voice surgeries in adults with gender incongruence, as recommended by the Australian Society of Plastic Surgeons (ASPS).

  
  

Problem Identification: 

Gender-affirming surgeries (GAS) have no dedicated MBS items. 

This means that these surgeries are accessed through non-specific MBS items or private health insurance, resulting in substantial out-of-pocket costs. According to the LGBTIQ+ Health Australia (LHA), ‘denying trans, gender-diverse, and non-binary (TGD) people access to gender affirming surgeries amounts to discrimination based on their gender identity’. Additionally, according to ACON, lack of access to GAS has been linked to poorer mental health in TGD communities.

Context: 

The MBS refers to a list of Medicare services that the Australian Government subsidises. Section 3C of the Health Insurance Act 1973 (Cth) empowers the Minister to add and/or amend items under the MBS, such as gender-affirming surgeries.

Trans, gender-diverse, and non-binary (TGD) refers to those ‘whose gender is different to what was presumed for them at birth’ (gender incongruence). It is estimated that around 1.5% of Australians are TGD. TGD people can experience gender dysphoria, defined by ACON as ‘the distress or unease sometimes experienced from being misgendered and/or when someone’s gender and body personally don’t feel connected or congruent.’ 

GAS refers to a range of surgical procedures used to better align an individual’s physical anatomy with their affirmed gender and, therefore, help reduce gender dysphoria. According to the LHA, these surgeries can be ‘medically necessary’ and lifesaving. While data is limited, one study reported that 0-31% of respondents had GAS and 4-64% wanted, but had not yet accessed, GAS.

The Medical Services Advisory Committee (MSAC) is currently considering an application from the ASPS for 30 gender-affirming surgeries to be added to the MBS.

Arguments:

Bretherton et al., from the University of Melbourne, noted that TGD people experience poorer mental health outcomes in comparison with the cisgender population, partially due to barriers in accessing healthcare. Research has consistently shown that GAS is associated with improved mental health and quality of life (MSAC, Zwickl et. al., the Australian Institute of Health and Welfare). Furthermore, researchers at the University of Melbourne have shown that TGD people who desire GAS experience worse mental health outcomes compared to those who have had GAS. They further found that TGD people who desire GAS experience ‘71% increased odds of reporting a lifetime suicide attempt’. 

According to the LHA, ‘the high cost of gender affirming surgeries can act as a significant barrier to access’ for TGD people. Bretherton et al. argued that the absence of publicly funded gender-affirming surgery involves substantial out-of-pocket costs (often ranging from $20,000 to over $100,000). ACON and the LHA argued that these costs become more prohibitive given that TGD people are more likely to be unemployed and are from a lower socioeconomic status. 

The ASPS noted that whilst some GAS are available on the MBS, rebates are not covered for adults experiencing gender incongruence, therefore discriminating against TGD people based on their gender identity. For example, as ACON highlighted, breast tissue reduction rebates are limited to cisgender men. They explained that cisgender people are therefore able to access surgeries that TGD people are unable to, even if both are for gender-affirming reasons. ACON further argued that this ‘suggests that the bodies of cis people are idealised and reinforced … while trans people are positioned as harming themselves, and clinically relevant interventions are seen as cosmetic rather than medically necessary.’

It is widely recognised that proactive investments in mental health lead to greater savings in the long run. While research has not specifically investigated the economic benefits of investing in GAS, the LHA suggested that ‘a return-on-investment analysis would support funding gender-affirming surgeries based on the benefits of saving lives, reducing the economic burden on mental health services, and losing fewer years of productive life to suicide.’

Advice/Solution Identification:

The LHA, Equality Australia, ACON, the Australian Medical Association and the ASPS have all called for the introduction of MBS items for GAS. According to the LHA, ‘increasing access to [GAS] will alleviate the distress that comes with gender incongruence and represents a crucial step toward achieving equitable healthcare for [TGD people] … ensuring that all Australians, regardless of their gender identity, can access the healthcare they need without experiencing financial hardship.’

Precedent:

There is international precedent for publicly funding gender affirming surgeries. In Canada, the United Kingdom and New Zealand, publicly funded GAS are provided through their health systems.

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Public Support: 

1. The Australian Society of Plastic Surgeons (ASPS)

2. LGBTIQ+ Health Australia 

3. Working it Out

4. The Australian Medical Association

5. Urological Society of Australia and New Zealand

6. ACON

7. Royal Australasian College of Surgeons

Broad Support (Support MBS items for GAS being added, but hasn’t specifically supported the ASPS’ application):

8. Equality Australia 

9. 150,000+ petition tabled in federal parliament (Petition EN3307 - Gender affirming surgery should be covered by Medicare)

News Coverage:

• ABC News  - “Transgender Australians waiting years for gender-affirming surgery, as Medicare bid looms”. Transgender Australians have been found to face year-long waits and high out-of-pocket costs for gender-affirming surgery due to limited providers and the absence of dedicated Medicare items. By: Ashleigh Barraclough | Fri 25 Aug 2023 - Read the article here. 

• The Pedestrian - “Trans Aussies Are Being Forced To Crowdfund Life-Saving Surgery That Medicare Doesn’t Cover”. As Medicare does not cover most gender-affirming surgeries, many trans people have reported being ‘forced’ to crowdfund or self-fund essential care. By: Steffanie Tan | Fri 3 July 2020 - Read the article here.

• ABC News  - “The hidden $100,000 price tag on being transgender”. One woman discussed the significant financial barriers to accessing gender-affirming care. By: Angela Lavoipierre | Fri 2 Mar 2018 - Read the Article here.

• SBS News - “What subsidised gender affirmation surgery would mean to trans Australians”. A petition with over 150,000 signatures calling for Medicare to subsidise gender‑affirming surgery has been tabled in federal parliament, and advocates described the coverage gap as ‘lifesaving’. By: David Aidone | Mon 22 Nov 2021 - Read the article here.

• The Guardian - “‘They just go to Thailand’: the long and costly wait for gender-affirming surgery in Australia”. Advocates have argued that Medicare’s lack of specific item numbers for gender‑affirming surgeries creates confusion and out‑of‑pocket costs of up to tens of thousands of dollars for private procedures. By: Steve Dow | Sun 23 Apr 2023 - Read the article here.

Where to go to learn more: 

1. Medical Services Advisory Committee (MSAC) - MSAC’s page on the ASPS’ application. It provides a summary of the application (including a full list of the proposed surgeries to be covered by Medicare) and various documents that summarise the MSAC’s advice to the Minister regarding the ASPS’ application. View here.

2. (2025) Medical Services Advisory Committee (MSAC) - MSAC’s public document providing updates on the progress of the application. View here.

3. (2025) The Conversation - Coverage and conducted interviews on the Medical Services Advisory Committee, considering whether Medicare should fund gender-affirming surgery for adults. Read the Article here.

4. TransHub - ACON’s online resource platform for clear and easy-to-understand information about TGD people. It provides a comprehensive explanation of various gender-affirming surgeries. Read about the different gender-affirming surgeries here.

5. Health Insurance Act 1974 (Cth) - Read the full Act here.

Human Perspective: 

TW: Discussion of gender dysphoria, financial barriers to gender-affirming surgery, mental health distress and personal trauma.

Without access to publicly funded surgeries, Alex’s life narrowed into a series of painful compromises, even after years of feeling emotionally drained by persistent gender dysphoria that touched almost every part of their daily life. They knew – through their doctors and their own lived experience – that gender-affirming surgery would be deeply beneficial for their mental health, offering relief from distress that had built up over time. Alex found themselves reading late-night stories of people travelling overseas for surgery because it was cheaper than staying in Australia, weighing the risks of being far from home during recovery against the reality that local care was financially impossible. They considered crowdfunding but felt conflicted as it was something so deeply personal. They felt that they were turning their body and wellbeing into a public plea for help. Each option demanded sacrifice, leaving them exhausted by the sense that easing years of dysphoria required giving up safety, stability, or dignity just to receive care they knew was necessary.

To protect the anonymity of those involved, this is a fictionalised account drawn from an amalgamation of real-life stories, experiences and testimonials gathered during the research process for this brief. Any resemblance to actual individuals is purely coincidental.

Conflict of interest/acknowledgment statement: 

N/A

Support 

If your organisation would like to add your support to this paper or suggest amendments, please email Info@foreaustralia.com. 

Reference list: 

ACON. (2019, November). A Language Guide: Trans and Gender Diverse Inclusion [Fact sheet]. https://www.acon.org.au/wp-content/uploads/2019/11/TGD-Language-Guide_2019_updated.pdf

Aidone, D. (2021). What subsidised gender affirmation surgery would mean to trans Australians. SBS News. https://www.sbs.com.au/news/article/what-subsidised-gender-affirmation-surgery-would-mean-to-trans-australians/0p36k4kwf

Ainge Roy, E. (2018, October 19). New Zealand reduces 30-year wait for gender reassignment surgery. The Guardian. https://www.theguardian.com/society/2018/oct/19/new-zealand-reduces-30-year-wait-for-gender-reassignment-surgery#:~:text=The%20New%20Zealand%20government%20has,people%20stretched%20into%20the%20decades.

Australian Institute of Health and Welfare. (2025). The role of gender affirmation and gender euphoria in mental health and suicidality among trans and gender diverse people in Australia. https://www.aihw.gov.au/suicide-self-harm-monitoring/population-groups/lgbtqia-sb-people/gender-affirmation?utm 

Australian Medical Association. (2024, February 6). LGBTQIASB+ Health Position Statement.  https://www.ama.com.au/articles/lgbtqiasb-health-position-statement 

Barraclough, A. (2023, August 25). Transgender Australians waiting years for gender-affirming surgery, as Medicare bid looms. ABC News. https://www.abc.net.au/news/2023-08-25/transgender-affirming-surgery-barriers-waiting-lists-costs/102473890 

Bretherton, I., Thrower, E., Zwickl, S., Wong, A., Chetcuti, D., Grossmann, M., Zajac, J. D., & Cheung, A. S. (2021). The Health and Well-Being of Transgender Australians: A National Community Survey. LGBT Health, 8(1), 42–49. https://doi.org/10.1089/lgbt.2020.0178 

Cheung, S., Dean, N., & Zwickl, S. (2025, August 29). Gender-affirming surgeries may be added to Medicare – but the evidence is still being reviewed. The Conversation. https://theconversation.com/gender-affirming-surgeries-may-be-added-to-medicare-but-the-evidence-is-still-being-reviewed-263714 

Department of Health and Aged Care. (2024). A Fit and Healthy Australia [Fact sheet]. https://www.health.gov.au/sites/default/files/2024-05/budget-2024-25-a-fit-and-healthy-australia.pdf 

Department of Health, Disability, and Ageing. (2025). MBS Online - Medicare Benefits Schedule. https://www.mbsonline.gov.au/

Department of Health, Disability, and Ageing. (n.d.). Medicare Benefits Schedule - Note GN.11.29. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.11.29 

Dow, S. (2023, April 23). ‘They just go to Thailand’: the long and costly wait for gender-affirming surgery in Australia. The Guardian. https://www.theguardian.com/society/2023/apr/23/they-just-go-to-thailand-the-long-and-costly-wait-for-gender-affirming-surgery-in-australia

Equality Australia. (2024, February 12). Equality Australia welcomes call from AMA to enhance access to gender affirming treatments. https://equalityaustralia.org.au/equality-australia-welcomes-call-from-ama-to-enhance-access-to-gender-affirming-treatments/

Health Insurance Act 1973 (Cth). https://www.legislation.gov.au/C2004A00101/latest/text

Lavoipierre, A. (2018, March 2). The hidden $100,000 price tag on being transgender. ABC News. https://www.abc.net.au/news/2018-03-02/the-hidden-%24100,000-price-tag-on-being-transgender/9498918 

LGBTIQ+ Health Australia. (n.d.). Submission on the MSAC application 1754: Patient consultations and surgical procedures for gender affirmation in adults with gender incongruence. https://assets.nationbuilder.com/lgbtihealth/pages/1156/attachments/original/1699404633/LHA_MSAC_Gender_Affirmation_Submission.pdf?1699404633

Medical Services Advisory Committee. (MSAC) (2025). 1754 – Surgical Procedures for Gender Affirmation in Adults with Gender Incongruence. Department of Health, Disability and Ageing. https://www.msac.gov.au/applications/1754

Medical Services Advisory Committee. (MSAC) (2025). Public Summary Document: Application No. 1754 – Surgical procedures for gender affirmation in adults with gender incongruence. Department of Health, Disability and Ageing. https://www.msac.gov.au/sites/default/files/2025-07/1754_final_psd_-_april_2025_1.pdf

Medical Services Advisory Committee. (MSAC) (2025). MSAC Application 1754: Patient consultations and surgical procedures for gender affirmation in adults with gender incongruence. Department of Health, Disability & Ageing. https://www.msac.gov.au/sites/default/files/documents/1754%2520Redacted%2520PICO%2520Set.pdf

National Health Service. (2023). Schedule 2 - The Services. https://www.england.nhs.uk/wp-content/uploads/2019/07/NHS-England-Service-Specification-for-Specialised-Gender-Dysphoria-Services-Surgical-v4.pdf

National Mental Health Commission. (n.d.). The economic case for investing in mental health prevention. Australian Government. https://www.mentalhealthcommission.gov.au/sites/default/files/2024-03/the-economic-case-for-investing-in-mental-health-prevention---summary.pdf

Parliament of Australia. (2021). Petition EN3307 - Gender affirming surgery should be covered by Medicare. https://www.aph.gov.au/e-petitions/petition/EN3307 

Richman, J. (2025, February 20). The Complete Guide to Gender-Affirming Surgery. Gender Confirmation Center. https://www.genderconfirmation.com/gender-affirmation-surgery/ 

Rosenberg, S., Duck-Chong, E., & Cook, T. (2021, November). Gender Affirming Surgery in Australia: An Evidence Brief. ACON. https://auspath.org.au/wp-content/uploads/2022/06/GenderAffirmingSurgery_EvidenceBrief.pdf?utm 

Tan, S. (2020, July 3). Trans Aussies Are Being Forced To Crowdfund Life-Saving Surgery That Medicare Doesn’t Cover. The Pedestrian. https://www.pedestrian.tv/health/miss-blanks-gender-affirmation-surgery-not-covered-medicare/ 

Trans Health Care (2022, March 24). Canada Finally Has Nation-Wide Funding For Gender-Affirming Surgeries. Trans Health Care. https://www.transhealthcare.org/news/canada-nation-wide-funding-for-gender-affirming-surgeries/ 

Trans Hub. For Trans Folk. https://www.transhub.org.au/trans-folk/#surgeries 

Wooden, M., Ey, T., & Wilkins, R. (2025). Economic, Social and Health Outcomes of the Transgender and Gender-Diverse Population in Australia. Australian Economic Review, 58(3), 199–210. https://doi.org/10.1111/1467-8462.70005 

Zwickl, S., Wong, A. F. Q., Dowers, E., Leemaqz, S. Y.-L., Bretherton, I., Cook, T., Zajac, J. D., Yip, P. S. F., & Cheung, A. S. (2021). Factors associated with suicide attempts among Australian transgender adults. BMC Psychiatry, 21, Article 81. https://doi.org/10.1186/s12888-021-03084-7